Healthcare Quality Flashcards
What is Quality defined as?
“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”
High-quality care involves providing patients with appropriate services in which areas?
- in a technically competent manner
- good communication
- Shared decision making
- Culture sensitivity
What is Quality Improvement defined as?
“Systematic and continuous actions that lead to measurable improvements in healthcare services and the health status of targeted patient groups”
What are the goals of quality management?
- evaluation of medical and nursing processes for quality and effectiveness compared to accepted standards
- Aims to provide cost-effective care by preventing overuse, misuse, and underuse of medical resources
What are the six aims for improvement?
Make sure care is:
- safe
- effective
- patient-centered
- timely
- efficient
- equitable
What three organizations focus on government agencies, physicians groups, professional nursing organizations having indicators of high-quality care and measures to document the quality of care?
- national database of nursing quality indicators
- patient safety and quality: An Evidence-Based Handbook for Nurses
- The Joint Commission’s National Patient Safety Goals
How does the Affordable Care Act contribute to a better quality of care?
- enacted to make healthcare affordable for all Americans
- Changes began to be implemented in 2010
- May change significantly in coming years
What are the broad aims of the US Department of Health and Human Services National Quality Strategy?
- better care
- health people/healthy communities
- Affordable care
What are the six priorities of high-quality care for the USDHHS National Quality Strategy?
- patient safety
- person and family-centered care
- Care coordination
- Effective prevention and treatment
- Healthy living
- affordability
What are the state and local initiatives for a better quality of care?
- Under ACA, states are partly responsible for providing state health insurance for low-income individuals and families
- ACA offers states the option of implementing a basic health program for low-income adults and legal immigrants
What are the steps to the Quality Improvement Process?
(Continuous/multistep/multilevel process)
- Identify areas for improvement based on performance and industry standards
- Analysis of current protocols and outcomes
- benchmarking
- Targeting areas for improvement
- Identifying factors that promote better outcomes
- Implementation of new protocols
- Evaluation of efficacy of new protocols
What does a peer review involve?
- professional critique of colleague’s work based on predetermined standards
- Nurses assess other nurses in a safe and non-punitive environment
- Nurses analyze complicated cases and determine standards by which they will collectively be held accountable
- Produces recommendations nursing staff will understand and accept
What are the parts of an analysis of current protocols and outcomes?
INTRAprofessional assessment:
- Peer review
- Audits
- Outcomes and management
INTERprofessional assessment
What is an audit?
- examination of records to verify accuracy and proper use
- usually examines financial or medical records
- can be for a single patient, group of similar patients, individual clinician, unit, or a whole facility
What is the difference between an intraprofessional and an interprofessional assessment?
Intra: focused on one discipline
Inter: focused on multiple disciplines
What is a retrospective audit?
performed after a patient’s discharge (recommendations made to change procedures if needed)
What is a concurrent audit?
performed while patient is undergoing care (allows for changes if needed to prevent adverse events or improve patient’s care)
What is outcomes management?
- uses patient experiences to guide improvement by providing a link between medical interventions and health outcomes and between health outcomes and cost of care
- can be used to discover areas for improvement and analyze areas of excellence
- NIH outcomes management program (PROMIS)
What are the parts of the outcomes management system?
- implement evidence-based practice systems
- guides case decision making
- Incorporates better, more efficient clinical management
- Provides information to improve services
What are the parts of the analysis of current protocols and outcomes?
Interprofessional assessment:
- assessment involving more than one discipline
- Includes peer reviews, audits, outcomes management
- utilization review
What is utilization review?
- analysis of the use of resources to identify areas of overuse, misuse, and underuse
- protects facility from unnecessary and inappropriate use of resources
- required by Medicaid for specific services
- required by the Joint Commission for facility accreditation
- May identify areas in which resources are overused (urinary catheterization for ambulatory patients)
- May identify areas in which resources are lacking (inadequate staffing)
What is benchmarking?
A method of comparing performance of a person or organization to industry standards
What are standards of care?
- They are standards based on established models of high-quality performance
- They may reflect the performance of industry leaders and scientific or clinical research recommendations of professional organizations
What is the Donabedian model of quality improvement?
- structure standards relate to material resources, human resources, general organizational structure
- process standards focus on steps used to lead to a particular outcome
- Outcome standards focus on performance of a process
What are the characteristics of benchmarking?
- statistics that reflect organization’s performance in a specific area
- must be measurable, objective, and sensitive to changes in performance
What is a sentinel event?
An unexpected occurrence involving death, serious physical or psychologic injury, or risk of injury
What are the events that follow after a sentinel event?
- root cause analysis: problem-solving to identify the root cause of faults
- A plan to reduce future risk of sentinel events
- Improvement implementation
- Monitoring effectiveness of improvements
- Joint Commission reviews facility’s response to sentinel events as a part of accreditation processes
What is Breach of Care?
occurs when a nurse does something that should not have been done or does not do something that should have been done
What are increased numbers of malpractice suits involving nurses related to?
- deficits in treatment and care management
- assessment
- monitoring
- Professional conduct
- Medication administration
How can nurses reduce the risk of committing a breach of care?
- Reporting problems to supervisors
- Remaining current in skills and education
- basing all care on the nursing model and documenting care patient response
What is risk management?
- proactive components to prevent adverse effects
- reactive components to minimize damage from adverse effects
- must occur daily
What is the risk management process?
- identifies the risks that may lead to patient injury, staff injury or financial loss
- Reviews systems that monitor risks
- Analyzes the frequency, severity, and cause of past adverse events
- Stays up to date on current healthcare-related laws
- Identifies need for patient and staff education
What are the goals of root cause analysis?
- identify reasons for failures or problems
- develop an action plan to decrease the likelihood of future adverse events
- Focus on systems and processes, not individual performance
- Analyzes special and common causes
What should the action plan of a root cause analysis include?
- identify who is responsible for implementing and overseeing improvements
- pilot testing
- timelines for implementing changes
- Strategies for measuring the effectiveness of changes
What is an adverse drug event?
the harm experienced by the patient as a result of exposure to a medication (about half are preventable)
What are high-alert medications?
- medications with a similar appearance or names but have very different chemical properties
- Medication that can cause problems in older adults
What are some strategies to help reduce medication errors?
- Barcoding patients’ ID bands and medications
- Regulating similar drug names that may cause confusion
- computerized physician ordering system
Why are staffing practices in nursing an area that needs to be addressed to promote better patient outcomes?
- decreased nurse staffing correlates with adverse patient outcomes
- Increased nursing workload associated with adverse outcomes
- An Increased ratio of LPN hours to the total nursing hours is associated with increases in mortality and sepsis rates in trauma patients
Reducing costs while maintaining or improving quality of care can be accomplished by reducing waste resulting from:
- unnecessary or inefficient services
- Prices that are too high
- excess administrative costs
- Missed prevention opportunities
- Medical fraud
Why is a blame-free environment important?
- healthcare providers can record errors or near misses without fear of punishment
- helps to identify problems so corrections can be made
What is Just Culture?
Tries to balance blame-free environment with appropriate accountability
What are the characteristics of Just Culture?
- focus on correcting problems that lead to engaging in unsafe behavior
- Establishing zero tolerance for reckless behavior
- Differentiates among human error, at-risk behavior, and reckless behavior
- Based on understanding that errors often result from system failures
- Recognizes that atmosphere of punishment impedes error prevention
- Focuses on system while maintaining individual accountability
- Requires buy-in from management and individual employees
What are some things that nurses should always take responsibility for to promote better outcomes?
All nurses should:
- never perform an act the nurse is unsure how to perform
- Show accountability for his/her actions
- Admit to errors if they occur
- Know the facility’s policies and procedures and follow them exactly
- Understand how to report errors
When implementing new protocols what is the most important step?
educate nurses and other clinicians about it (i.e. the importance of the new process, steps involved, and associated reporting procedures)
What is quality assurance?
the process of collecting and analyzing data to determine whether standards are being met
What is comprehensive quality management?
used to help healthcare facilities integrate new programs, models, and technologies with primary care services already in place
What characteristics should a comprehensive quality management program have?
- Should address improving experience of care, population health, and per capita costs
- Should address quality and safety in all aspects of organization
- Should be patient focused
What is Total Quality Management (TQM)?
- quality and productivity improved by using data and statistics to improve systems
- involves teamwork throughout the organization, including suppliers and customers
What are the essential elements to Total Quality Management?
- communication
- feedback
- fact-based decision making
- Focus on continual improvement
What is the Plan-Do-Study-Act cycle?
- define the goal, collect data, outline strategy
- implement a plan on a small scale
- Analyze outcomes and compare to expected outcomes
- Decide whether the goal is met, the plan needs further changes, and how to implement
What is continuous quality improvement?
Can be applied to a specific problem, the development and implementation of policies, or implementation of evidence-based practices
Who are internal customers?
employees, including nurses
Who are external customers?
- individuals who seek healthcare
- their family members, significant others
- Insurance companies, suppliers, agencies, and law enforcement
What is the DMAIC system?
- D- Define the problem
- M- Measure data related to the current process, problem, and desired goal
- A- analyze data to determine cause-and-effect relationships related to the problem
- I-improve by developing and implementing solutions to problems
- C- Control by implementing measures and continuous monitoring to ensure goals are being met
What is DMADV methodology?
Define, Measure, Analyze, Design, and Verify
What is Six Sigma?
- A program to reduce variation within a process to produce a near-perfect product
- Uses teams of people with intimate knowledge of the problem and training in Six Sigma Principles
- Most successful when whole organization is involved in planning and implementing
What is Lean Six Sigma?
- combines Six Sigma strategies with Lean system
- Objective: to eliminate waste to maximize value
- Primarily uses DMAIC system
